community-based participatory research for quality assurancecommunity-based participatory research...

Community-based participatory

research for quality assurance

Daniela Rojas Castro, PhD

Coalition PLUS

France

Coalition PLUS

International network of community NGOs to fight HIV / AIDS and viral hepatitis.

Our mission:

Contribute to the elimination of HIV/AIDS and viral hepatitis, in accordance with the objectives set by the international community.

● 13 members

● 100 partners

● 40 countries

FAST TRACK CITIES:

THE FRAMEWORK

IMPLEMENTATION PLAN

90-90-90

&

Zero Discrimination

PROGRAMS INTERVENTIONS

M & E

PROCESS & OVERSIGHT

COMMUNICATIONS

RESOURCE MOBILIZATION

IAPAC, 2016

+

IAPAC, 2016

COMMUNITY-BASED

PARTICIPATORY RESEARCH

Community-based research is not...

Low-cost research (no rigor, not publishable)

Interventional or action research

The evaluation of associative programs

Social Sciences

Research without researchers

Research using communities to fulfill an obligation without real community engagement

Community-based research is...

A balanced partnership between

researchers and community actors

who do research together guided by

the needs of the groups concerned

and aimed at social transformation

Principal to “do with” and not “to do for”

Mobilisation of concerned groups who express their needs

Problems identified in the field by community agents

Takes into account “lay” knowledgeResponds to the same

methodological requirements as any other scientific research

Science:To contribute to the advance of knowledge, by offering access

to new information and to a variety of analyses.

Social Transformation:To strengthen community and

transform results into action in the form of practical fields

interventions.

Community-based research - A double goal

Community-based research

Advocacy

Social Transformation

Do we really need more

research and especially

community-based

participatory research!? Today we have the

right data, right tools,

and right leadership

to end the HIV

epidemic.

BEFORE, DURING AND AFTER THE “90-90-90”

WE NEED COMMUNITY-BASED RESEARCH

FOR REACHING THE “10-19-27”

Before the 90-90-90Respond to people’s needs

• Integrating key populations in a

sexual health pathway

• Provision of culturally adapted

sexual health services (ex. peer-led

PrEP counseling: ANRS-Prevenir)

Status-Neutral Approach to HIV (Myers et al. 2018)

Before the 90-90-90Data are political

First 90

People know their HIV status

• Most difficult step to achieve among majority of countries.

• Need to develop interventions targeted to populationsnot successfully reached by health centers.

• Exemple: Hermetic - Paris (France) -

HERMETIC - Paris

Mathematical modeling to identify the “hidden epidemic” in

France: migrant men (heterosexuals and MSM) from

sub-Saharan Africa living outside Paris.

How can we improve our capacity to reach individuals from

sub-Saharan Africa?

Literature, brainstorming and discussions led the decision

to experiment a new approach to HIV testing: door-to-door.

HERMETIC - Paris

HERMETIC - Paris

● 739 door-to-door contacts: 290 with people born in SSA (143 men

et 147 women)= 39,2%

● 142 rapid tests with SSA born people at the van and 43 at home.

● More native Sub-Saharan African people were reached than in

classical interventions.

● Fewer MSM were reached than in a classical interventions.

● This intervention reached people who reported a less frequent

use of condoms during the last sexual act than in classical

interventions.

Second 90

PLHIV are on treatment

• Barriers still exist to accessing health care, especially for

key populations facing stigma and discrimination.

• Need to identify and overcome specific barriers in local

context.

• Example: TB-Check - Bucharest (Romania) -

TB-CHECK - Bucharest

● 1339 PWID diagnosed HIV-positive (2007-2017) (CNLAS, 2017),

with an important increase in TB cases among this population.

● Implementation of a study to understand the underlying reasons for

this refusing treatment (December 2017-March 2018) through the

project “Treatment for all, now!” funded by the Global Fund,

Romanian Angel Appeal Foundation.

● Mix-methods approach (N=116)

TB-CHECK - Bucharest

● Rewarded referrals were the most efficient method to successfully

link PWID to TB services.

● Emotional status and physical appearance of PWID are major

barriers to linkage to care.

● Adapted schedule and less restrictive conditions could increase

PWID’s attendance to TB dispensaries, in addition to peer support

and information.

● Need to develop an integrated approach within medical, social

and community-based services: one patient, one place, all

needed services.

Third 90

PLHIV are undetectable

• Achieving viral suppression is dependent on regular medical follow-up and treatment adherence.

• Need to set up interventions that address treatment adherence issues.

• Example: therapeutic education among PLHIV -Cochabamba (Bolivia)

Therapeutic education among PLHIV -

Cochabamba

Objectives:

● To evaluate the effectiveness of therapeutic education

program (TEP) with regards to antiretroviral treatment

adherence.

● Compare the percentage of patients with an undetectable viral

load among those who participated in the TEP and those who

did not.

● Determine the factors associated with treatment adherence in

both study groups.

Therapeutic education among PLHIV -

Cochabamba

● Among those in the TEP, 95% achieved an undetectable viral

load at the last follow-up session (versus 68% of those not

participating in the TEP).

● The percentage of PLHIV with an undetectable viral load

between the first and the second follow-up session increased

by 45% among participants in the TEP (versus 31%).

● Among those in the TEP, men achieved a higher percentage of

undetectable viral load (50% compared to 33% among

women).

After the 90-90-90Fight against STIGMA

A final wordCommunity-based research...

● Can better identify people’s needs.

● Can improve the pertinence and quality of data.

● Can help better understand local epidemic(s).

● Puts into place sustainable solutions that can have a

strong(er) impact thanks to community engagement.

● Mobilises concerned communities.

● Addresses the needs of the 10%-19%-27% who are in

the margins of society and of traditional health care

services.

● Let’s work more and better together!

@drojascastro

drojascastro@coalitionplus.org

For more information on community-based research at

Coalition PLUS (EN, FR, ES): http://www.coalitionplus.org/brochure-recherche-communautaire-vih/